Expert nursing practice: A mathematical explanation of Benner's 5th stage of practice development

Aim: This paper is a report of a study exploring the experience of intuition in emergency nursing in relation to Benner’s fifth stage of practice development, ‘the expert practitioner’. Background: Expert nurses anecdotally report actions and thoughts that present in their consciousness and have an impact on the care given. Benner used the term intuition for the 5th stage of practice development. However, Paley has criticised Benner’s model for its lack of clarity about the nature of an expert practitioner. This criticism is further justified by Benner’s inadequate explanation of expert. Method: A hermeneutic phenomenological study was conducted using van Manen’s approach and a Gadamerian analysis. Fourteen expert emergency nurses in Australia were interviewed between January 2000 and December 2003. Findings: The analysis resulted in the reconstruction of Benner’s expert stage into three distinct phases: cognitive intuition, where assessment is processed subconsciously and can be rationalised in hindsight; transitional intuition where a physical sensation and other behaviours enter the nurse’s awareness; and embodied intuition when the nurse trusts the intuitive thoughts. Conclusion: The findings validate the use of intuitive decision-making as a construct in explaining expert clinical decision-making practices. The validity of intuitive practice should be recognised. It is essential to recognise the conditions that support practice development, and in the pre-novice stage (during their university course) factors such as reflection, research (in its broadest sense) and clinical curiosity should be fostered.